John H. Woo, MD Associate Professor, Department of Radiology Perelman School of Medicine, University of Pennsylvania Medical Center October 28, 2016
|
|
- Andrea James
- 5 years ago
- Views:
Transcription
1 John H. Woo, MD Associate Professor, Department of Radiology Perelman School of Medicine, University of Pennsylvania Medical Center October 28, 2016
2 Cerebrospinal fluid (CSF) Bulk model (traditional) Production: 500 ml/day 150 ml total volume Choroid plexus Arachnoid villi Multicompartmental model Blood Interstitial fluid Virchow-Robin spaces CSF (Cervical) lymphatics CSF pulsations Absorbers Compliance? Brinker T, Stopa E, Morrison J, Klinge P, A new look at cerebrospinal fluid circulation, Fluids and Barriers of the CNS (2014) 11:10.
3 Hydrocephalus Obstructive v communicating Look for transition point of obstruction! Congenital v acquired Idiopathic v secondary Meningitis, subarachnoid hemorrhage, carcinomatosis inph Acute v chronic Ex vacuo = atrophy/encephalomalacia
4 Hydrocephalus - presentation Acute Headache Lethargy/malaise Nausea/vomiting Papilledema Rapid head enlargement (children) Chronic Progressive gait dysfunction magnetic, shuffling Dementia Frontal, subcortical Urinary incontinence Detrusor overactivity UMN signs May be asymptomatic
5 Obstructive hydrocephalus Acute Early: temporal horn III convexity, floor Periventricular changes Chronic Ventricular > sulcal enlargement Thin, elevated callosum Expanded III recesses
6 Normal Pressure Hydrocephalus Described by Adams/Hakim NEJM (1965) 273: Triad: gait disturbance, dementia, incontinence Ventriculomegaly without elevated ICP Secondary vs. idiopathic (inph) Many subsequent articles do not distinguish inph: Unknown etiology and mechanism inph Guidelines published probable/possible/unlikely Neurosurgery (3):4-16.
7 inph clinical aspects Elderly (> 60 yo) >40 in 2005 guidelines Gait (balance), cognition, urinary continence Gait tends to be earliest, responds best to shunting Tap test (TT) - popular >30 ml do symptoms improve? External Lumbar Drainage (ELD) CSF infusion tests: measure Rout (resistance to CSF outflow)
8 Ventriculomegaly: Can radiologists distinguish NPH from atrophy? Each of NPH triad can be caused by many pathologies in the elderly Ataxia: Parkinson s, spinal stenosis, arthritis, neuropathy, Dementia: CVA, Alzheimer s, neurodegenerative disease, Incontinence: urologic disease, (potentially) treatable cause of neurologic deficit However, shunting is not benign Early series (1992, 127 pts): 36% improvement/28% complications Vanneste et al, Neurology (1992) 42: Appealing idea: can imaging distinguish/predict shunt response?
9 Ventriculomegaly: Should radiologists distinguish NPH from atrophy? NPH is a clinical diagnosis, informed by imaging Atrophy also causes ventriculomegaly NPH and Alzheimer s Disease can co-exist make or refute the diagnosis without full clinical data? Ideal world: knowledgeable clinician takes imaging into account, makes/refutes diagnosis. Real world:??
10 Evans ratio or index A = transverse measure across frontal horns (yellow) B = max intracranial biparietal diameter, same slice (red) Evans Ratio = A/B (0.44 in example to the right) NPH guidelines: EI > 0.3. (EI > 0.33 more specific)
11 White matter signal Periventricular signal Supportive feature in 2005 guidelines However, not essential Not a criterion in Japanese trials Ischemic disease: negative predictor? Conflicting studies 2-hit hypothesis? (Bradley, et al, JMRI (4): ) Confounds: common in elderly difficult to distinguish
12 Callosal angle Coronal plane perpendicular to AC-PC Acute (< 90 ) = NPH. Obtuse (> 90 ) = atrophy Ishii K et al, Eur Radiol (2008) 18:
13 Focally dilated sulci Initially described in 1998 Kitagaki et al (1998) AJNR 19:1277. Holodny et al (1998) J Neurosurg 89(5): Sylvian fissures and basal cisterns may also dilate
14 DESH pattern Disproportionately Enlarged Subarachnoid-Space Hydrocephalus Ventriculomegaly Tight high convexity/medial sulci Many have enlarged Sylvian fissures
15 Developing DESH? Or risk of developing NPH? 4 years later
16 SINPHONI trial (2010) Multicenter trial in Japan, 100 patients Inclusion criteria: >60 yo, normal CSF, idiopathic Any component of triad DESH pattern Results: 12-m improvement 69 77% Confirms diagnostic value of DESH specific to inph? Hashimoto M et al, Cerebrospinal Fluid Research :18
17 SINPHONI-2 trial (2015) Multicenter trial, n=93, lumboperitoneal shunt Same inclusion criteria as SINPHONI 49 randomized to immediate shunt; 44 waited 3 mo Results: 63% 12 3 mo: 65% in group 1; 2% in group 2 (p<0.0001) Adverse events (22%): shunt malfunction/overdrainage Post hoc analysis: TT predictive of shunt response Kazui H et al, Lancet Neurology 2015 Jun; 14(6): Yamada S et al, J Neurosurg 2016 Jul (online); DOI: / JNS16377.
18 European inph trial (2012) Multicenter trial in Europe, n= inph T (typical) based on clinical criteria 55 inph Q (questionable) 28 severe cognitive deficits; 27 non-typical gait or MRI with atrophy/infarcts/svid Shunt performed regardless of CSF TT and Rout tests Results: High dropout (19%), but 69-84% improved Only minor differences b/w T and Q both improved TT and Rout had high PPV (>90%) but low NPV (<20%) Klinge P et al, Acta Neurol Scand 2012 Sep; 126(3): Wikkelso C et al, J Neurol Neurosurg Psychiatry 2013; 84:
19 Craniomegaly in NPH? Hypothesis: NPH (or risk thereof) begins as benign external hydrocephalus in infancy Measured cranial volume by manual outlining T2WI Compared NPH (22M/29W) to controls (55M/55W) M: NPH ~ 7.5% larger (P=0.003); W: ~6.3% (P=0.002) Another study showed unexpectedly large # of inph with large HC (19.6% at 90%ile; 8.9% at 97%ile) Bradley WG et al, AJNR 2004; 25: Wilson RK et al, JNNP 2007; 78:
20 Nuclear medicine cisternography? ventricular reflux, delayed accumulation or clearance Practice Guidelines for inph (2015) found insufficient evidence for its use Halperin JJ et al, Neurology 2015; 85: hours 24 hours 48 hours
21 CSF flow imaging with cine PC-MRI Gated sequence (pulse ox, ECG) to detect cardiac cycle Retrospective gating (Nitz et al, Radiology 1992; 183: ) Motion across gradient induces phase shift direction and magnitude of velocity Ideal plane perpendicular to flow to quantify Velocity-Encoding Gradient (VENC): max encodable v (180 ) Look for aliasing! (VENC too low) Usually 5, 10, 20 cm/sec for CSF flow studies
22 Hyperdynamic aqueductal flow Flow void predicts surgical outcome? (note: extent) Bradley WG et al, Radiology 1991; 178:459 FV scores associated with shunt response (P<0.003) Not reproduced (e.g. Krauss JK et al, Neurosurgery 1997; 40:67)
23 CSF flow in the aqueduct Orthogonal plane to aqueduct (inf) Velocity (cm/s) Flow (ml/min) Volume ( L)
24 CSF aqueductal flow: prognostic? SV > 42 L predicts shunt response (6/6)? Bradley WG et al, Radiology 1996; 198:523. Scanner-dependent Not reproduced (Kahlon, Neurosurgery :124) (n=38) Flow > 18 ml/min suggests inph? Luetmer PH et al, Neurosurgery :534. Measured in normal, MCI, AD, inph NL 8.4 ml/min / (78 beats/min) SV=54 L CBF flow did not predict SR (n=49) Dixon GR et al, Mayo Clin Proc (6):509.
25 Prognostic value of MRI in inph Virhammer et al, AJNR 2014 Dec; 35: Studied (anatomic) imaging findings to predict 12-mo SR Logistic regression model, N=108 Significant (5%): Callosal angle, DESH (y/n), temporal horn Trend (10%): EI, FV, focal lateral ventricle bulgings Not: narrow high sulci, Sylvian F, III, WM, focal enlarged sulci
26 Adult-onset aqueductal stenosis Assess with high-resolution MRI and cine PC-MRI
27 Endoscopic Third Ventriculostomy (ETV) evaluation Case courtesy of Dr. Arastoo Vossough, Children s Hospital of Philadelphia
28 Chiari I malformation Anatomic definition: tonsillar descent below FM <3 mm Normal ( tonsillar ectopia ) 3-5 mm Borderline >5 mm CMI when > 15 yo >6 mm CMI when < 15 yo McVige et al, Curr Pain Headache Rep :18. Barkovich AJ et al, AJNR :795.
29 How to measure: McRae line basion (clivus) to opisthion (basiocciput) cortex to cortex (black line) Drop perpendicular to tonsil Left and Right measures Thin-section imaging (SPACE, CISS, MPRAGE) Sagittal T2WI NINDS CDE Working Group for Chiari I v0.0
30 Related entities? Chiari 0: Syrinx but no hindbrain herniation? Intermittent caudal descent with valsalva?? Arachnoid veil or adhesions? Crowded FM? CMI decompression surgery treats syrinx Iskander BI et al, J Neurosurg :212. Chiari 1.5: CMI + elongated brainstem and IV
31 Bony abnormalities Klippel-Feil Occipitoatlantal coalition/fusion/assimilation Tubbs RS, Neurosurg Clin N Am :487 Small PF Odontoid orientation Retroflexion pb-c2 measure NINDS CDE Working Group for Chiari I v0.0
32 Intracranial Hypotension (SIH) (acquired) Chiari Pituitary mass Sagging hypothalamus Dural enhancement Years later, still with headaches
33 Disordered CSF flow in CMI FM VENC 5-10 Sagittal plane Ventral >> Dorsal velocities Fakhri A et al, Neurosurg Clin N Am :519
34 Disordered CSF flow in CMI Axial plane below tonsils (Haughton) Flow jets Synchronous Bidirectional Flow Quigly MF et al, Radiology 2004; 232:229.
35 Post-op imaging Further decompression?
36 Thank you!
Alternate Methods: Pros and Cons (With a Focus on NPH)
Alternate Methods: Pros and Cons (With a Focus on NPH) William G. Bradley, Jr, MD, PhD, FACR Professor and Chair Department of Radiology University of California, San Diego Alternate Imaging Methods for
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/35771 holds various files of this Leiden University dissertation. Author: Palm, Walter Miguel Title: Ventricular dilatation in aging and dementia Issue
More informationPublished July 10, 2014 as /ajnr.A4046
Published July 10, 2014 as 10.3174/ajnr.A4046 ORIGINAL RESEARCH BRAIN Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus J. Virhammar, K. Laurell,
More informationUtility of radiologic imaging in the diagnosis and follow up of normal pressure hydrocephalus
Utility of radiologic imaging in the diagnosis and follow up of normal pressure hydrocephalus Poster No.: C-0312 Congress: ECR 2015 Type: Scientific Exhibit Authors: C. Rodríguez, D. Marquina, A. Mir Torres,
More informationFalling and Forgetting
Falling and Forgetting Dr TC Chan Dr LW Chu Inter-hosipital Geriatric Meeting 29-5-2009 Case 1 Mr A 86/M ADL-I Walk unaided Live with family Non smoker non drinker Good past health Attend A&E 10/2008 due
More informationThe classic teaching is that cerebrospinal fluid is formed primarily. CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus
REVIEW ARTICLE CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus W.G. Bradley Jr ABSTRACT SUMMARY: CSF normally flows back and forth through the aqueduct during the cardiac cycle. During
More informationNormal and Abnormal Cerebrospinal Fluid Dynamics Evaluated by Optimized Cine Phase-contrast MR Imaging
Chin J Radiol 2000; 25: 191-195 191 ORIGINAL ARTICLE Normal and Abnormal Cerebrospinal Fluid Dynamics Evaluated by Optimized Cine Phase-contrast MR Imaging LUNG-HUI GIIANG 1,3 CHENG-YU CHEN 1 MING-YEN
More informationThe Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1291-1296 Role of MRI CSF Flowmetry in Evaluation of Hydrocephalus in Pediatric Patients Abeer Maghawry Abdelhameed, Eman Ahmed Fouad
More informationMeninges and Ventricles
Meninges and Ventricles Irene Yu, class of 2019 LEARNING OBJECTIVES Describe the meningeal layers, the dural infolds, and the spaces they create. Name the contents of the subarachnoid space. Describe the
More informationComplex Hydrocephalus
2012 Hydrocephalus Association Conference Washington, DC - June 27-July1, 2012 Complex Hydrocephalus Marion L. Walker, MD Professor of Neurosurgery & Pediatrics Primary Children s Medical Center University
More informationIntracranial CSF Flow in Pediatric Hydrocephalus: Evaluation with Cine-MR Imaging
Intracranial CSF Flow in Pediatric Hydrocephalus: Evaluation with Cine-MR Imaging Robert M. Quencer 1 Purpose: 1) To describe the pattern of normal intracranial CSF flow in children and 2) to demonstrate
More informationDepartment of Neurosurgery, Shinko Hospital, Kobe, Japan
CLINICAL ARTICLE J Neurosurg 127:1436 1442, 2017 Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure
More informationChiari Malformations. Google. Objectives Seventh Annual NKY TBI Conference 3/22/13. Kerry R. Crone, M.D.
Chiari Malformations Kerry R. Crone, M.D. Professor of Neurosurgery and Pediatrics University of Cincinnati College of Medicine University of Cincinnati Medical Center Cincinnati Children s Hospital Medical
More informationDjamila Kafoufi Al Galaa Military Hospital Cairo
Djamila Kafoufi Al Galaa Military Hospital Cairo Herniation cerebellar tonsils below the foramen magnum, Hans Chiari 4 types Chiari I less than 5mm,HDC rare,syringomyelia often present. Chiari II,protrusion
More informationCSF flowmetry: an innovative technique in diagnosing normal pressure hydrocephalus
International Journal of Advances in Medicine Senger KPS et al. Int J Adv Med. 2017 Jun;4(3):682-687 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20171996
More informationIntroduction to Neurosurgical Subspecialties:
Introduction to Neurosurgical Subspecialties: Pediatric Neurosurgery Brian L. Hoh, MD 1 and Gregory J. Zipfel, MD 2 1 University of Florida, 2 Washington University Pediatric Neurosurgery Pediatric neurosurgeons
More informationEstimation of CSF Flow Resistance in the Upper Cervical Spine
NRJ Digital - The Neuroradiology Journal 3: 49-53, 2013 www.centauro.it Estimation of CSF Flow Resistance in the Upper Cervical Spine K-A. MARDAL 1, G. RUTKOWSKA 1, S. LINGE 1.2, V. HAUGHTON 3 1 Center
More informationInfusion studies in clinical practice. Kristian Aquilina Consultant paediatric neurosurgeon Great Ormond Street Hospital London
Infusion studies in clinical practice Kristian Aquilina Consultant paediatric neurosurgeon Great Ormond Street Hospital London 10 th September 2018 infusion study + hydrocephalus 216 publications Clinical
More informationPHYSIOLOGY OF CSF AND PATHOPHYSIOLOGY OF HYDROCEPHALUS
PHYSIOLOGY OF CSF AND PATHOPHYSIOLOGY OF HYDROCEPHALUS Introduction Dynamic component of CNS Invaluable tool to diagnosis Physiological reservoir of human proteome Reflects the physiologic state of CNS
More informationIdiopathic cervical syringomyelia can be associated. Pediatric Chiari malformation Type 0: a 12-year institutional experience.
J Neurosurg J Neurosurg Pediatrics Pediatrics 8:000 000, 8:1 5, 2011 Pediatric Chiari malformation Type 0: a 12-year institutional experience Clinical article Joshua J. Chern, M.D., Ph.D., Amber J. Gordon,
More informationThe Challenges of Normal Pressure Hydrocephalus
CE/CME The Challenges of Normal Pressure Hydrocephalus A Case-Based Review Freddi Segal-Gidan, PA, PhD Idiopathic normal pressure hydrocephalus (inph) is one of the few reversible causes of dementia. Unfortunately,
More informationRole of MRI in Selection of Patients for Surgery and Assessing the Post Operative Outcome in Chiari 1 Malformation
DOI: 10.7860/IJARS/2017/13599:2222 Radiology Section Original Article Role of MRI in Selection of Patients for Surgery and Assessing the Post Operative Outcome in Chiari 1 Malformation Rajesh Kumar V,
More informationParkinsonism after Shunting for Hydrocephalus Secondary to Aqueductal Stenosis with Chiari Malformation
ISPUB.COM The Internet Journal of Neurosurgery Volume 6 Number 2 Parkinsonism after Shunting for Hydrocephalus Secondary to Aqueductal Stenosis with Chiari M Turgut Citation M Turgut. Parkinsonism after
More informationTime-Spatial Labeling Inversion
White Paper Time-Spatial Labeling Inversion Cerebrospinal Fluid Flow Evaluation Erin Kelly, PhD Clinical Marketing Scientist, MR Canon Medical Systems INTRODUCTION Impairment to the natural flow of cerebrospinal
More informationDepartment of Cognitive Science UCSD
Department of Cognitive Science UCSD Verse 1: Neocortex, frontal lobe, Brain stem, brain stem, Hippocampus, neural node, Right hemisphere, Pons and cortex visual, Brain stem, brain stem, Sylvian fissure,
More informationNEURO IMAGING 2. Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity
NEURO IMAGING 2 Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity I. EPIDURAL HEMATOMA (EDH) LOCATION Seventy to seventy-five percent occur in temporoparietal region. CAUSE Most likely caused
More informationMagnetic resonance imaging (MRI) depicts cerebral tissue without
Diagn Interv Radiol 2009; 15:227 231 Turkish Society of Radiology 2009 NEURORADIOLOGY ORIGINAL ARTICLE Cine phase-contrast MRI evaluation of normal aqueductal cerebrospinal fluid flow according to sex
More informationNatural history of idiopathic normal-pressure hydrocephalus
DOI 10.1007/s10143-011-0316-7 REVIEW Natural history of idiopathic normal-pressure hydrocephalus Ahmed K. Toma & Simon Stapleton & Marios C. Papadopoulos & Neil D. Kitchen & Laurence D. Watkins Received:
More informationDisclosures None. Common Neurosurgical Problems Seen in Office Encounters. Macrocephaly Low Back Pain Sacral Dimple Concussion Chiari Malformation
Common Neurosurgical Problems Seen in Office Encounters When to Manage, When to Refer Andrew Jea MD FAAP Professor and Chief of Pediatric Neurosurgery Riley Hospital for Children Indiana University School
More informationAnatomy, Terminology and Treatment in Pediatric Neurosurgery Part I
Anatomy, Terminology and Treatment in Pediatric Neurosurgery Part I John Ragheb, MD, FACS, FAAP Professor of Neurosurgery and Pediatrics, Affiliated Faculty of University of Miami, Miller School of Medicine
More informationWhat Every Spine Surgeon Should Know About Neurosurgical Issues
What Every Spine Surgeon Should Know About Neurosurgical Issues Amer Samdani, MD Chief of Surgery Shriners Hospitals for Children Philadelphia, PA Objectives Main intraspinal lesions Chiari malformation
More informationMorphometric Analysis of Left & Right Tonsils in Adult Symptomatic Type 1 Chiari Patients and Healthy Controls
The University of Akron IdeaExchange@UAkron Honors Research Projects The Dr. Gary B. and Pamela S. Williams Honors College Spring 2015 Morphometric Analysis of Left & Right Tonsils in Adult Symptomatic
More informationCNS Embryology 5th Menstrual Week (Dorsal View)
Imaging of the Fetal Brain; Normal & Abnormal Alfred Abuhamad, M.D. Eastern Virginia Medical School CNS Embryology 5th Menstrual Week (Dorsal View) Day 20 from fertilization Neural plate formed in ectoderm
More informationbrain MRI for neuropsychiatrists: what do you need to know
brain MRI for neuropsychiatrists: what do you need to know Christoforos Stoupis, MD, PhD Department of Radiology, Spital Maennedorf, Zurich & Inselspital, University of Bern, Switzerland c.stoupis@spitalmaennedorf.ch
More informationChapter 3. Structure and Function of the Nervous System. Copyright (c) Allyn and Bacon 2004
Chapter 3 Structure and Function of the Nervous System 1 Basic Features of the Nervous System Neuraxis: An imaginary line drawn through the center of the length of the central nervous system, from the
More informationSpinal Imaging. Bearbeitet von Herwig Imhof. 1. Auflage Taschenbuch. 312 S. Paperback ISBN Format (B x L): 12,5 x 19 cm
Spinal Imaging Bearbeitet von Herwig Imhof 1. Auflage 2007. Taschenbuch. 312 S. Paperback ISBN 978 3 13 144071 6 Format (B x L): 12,5 x 19 cm Weitere Fachgebiete > Medizin > Sonstige Medizinische Fachgebiete
More informationTypical idiopathic intracranial hypertension Optic nerve appearance and brain MRI findings. Jonathan A. Micieli, MD Valérie Biousse, MD
Typical idiopathic intracranial hypertension Optic nerve appearance and brain MRI findings Jonathan A. Micieli, MD Valérie Biousse, MD A 24 year old African American woman is referred for bilateral optic
More informationCISTERNOGRAPHY (CEREBRO SPINAL FLUID IMAGING): A VERSATILE DIAGNOSTIC PROCE DURE
VOL. 115, No. i E D I T 0 R I A L CISTERNOGRAPHY (CEREBRO SPINAL FLUID IMAGING): A VERSATILE DIAGNOSTIC PROCE DURE C ISTERNOGRAPHY (CSF imaging) is a diagnostic study based on the premise that certain
More informationSpontaneous Intracranial Hypotension Diagnosis and Treatment
Spontaneous Intracranial Hypotension Diagnosis and Treatment John W. Engstrom MD, Philip R. Weinstein MD, and William P. Dillon M.D. University of California, San Francisco Spontaneous Intracranial Hypotension
More informationINTRACRANIAL ARACHNOID CYSTS: CLASSIFICATION AND MANAGEMENT. G. Tamburrini, Rome
INTRACRANIAL ARACHNOID CYSTS: CLASSIFICATION AND MANAGEMENT G. Tamburrini, Rome Incidence 2% of occasional neuroradiological findings From clinical studies (1960 s): 0.4-1% of intracranial space occupying
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationHead CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD
Head CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD Five Step Approach 1. Adequate study 2. Bone windows 3. Ventricles 4. Quadrigeminal cistern 5. Parenchyma
More informationBrain Meninges, Ventricles and CSF
Brain Meninges, Ventricles and CSF Lecture Objectives Describe the arrangement of the meninges and their relationship to brain and spinal cord. Explain the occurrence of epidural, subdural and subarachnoid
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationNeurosonography: State of the art
Neurosonography: State of the art Lisa H Lowe, MD, FAAP Professor and Academic Chair, University MO-Kansas City Pediatric Radiologist, Children s Mercy Hospitals and Clinics Learning objectives After this
More informationBrain Imaging. Bearbeitet von Klaus Sartor, Stefan Hähnel, Bodo Kress
Brain Imaging Bearbeitet von Klaus Sartor, Stefan Hähnel, Bodo Kress 1. Auflage 2007. Taschenbuch. 312 S. Paperback ISBN 978 3 13 143961 1 Format (B x L): 12,5 x 19 cm Weitere Fachgebiete > Medizin > Sonstige
More informationIn the spinal canal, oscillatory CSF flow results primarily from
Published July 10, 2014 as 10.3174/ajnr.A4023 REVIEW ARTICLE Spinal Fluid Biomechanics and Imaging: An Update for Neuroradiologists V. Haughton and K.-A. Mardal ABSTRACT SUMMARY: Flow imaging with cardiac-gated
More informationClinical Study Endoscopic Third Ventriculostomy in Previously Shunted Children
Minimally Invasive Surgery Volume 2013, Article ID 584567, 4 pages http://dx.doi.org/10.1155/2013/584567 Clinical Study Endoscopic Third Ventriculostomy in Previously Shunted Children Eva Brichtova, 1
More informationIdiopathic normal pressure hydrocephalus (inph) is an
J Neurosurg 120:178 184, 2014 AANS, 2014 The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus Clinical article Johan Virhammar, M.D., 1 Katarina Laurell,
More informationEnhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD
Enhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD Boston Children s Hospital Harvard Medical School None Disclosures Conventional US Anterior fontanelle
More informationKhalil Zahra, M.D Neuro-interventional radiology
Khalil Zahra, M.D Neuro-interventional radiology 1 Disclosure None 2 Outline Etiology and pathogensis Imaging techniques and Features Literature review Treatment modalities Endovascular techniques Long
More informationSA CME Information SA CME INFORMATION
S CME INFORMTION S CME Information Description Imaging of hydrocephalus Hydrocephalus is a a mechanical complication of different pathologic conditions and a disease process itself. The morphologic features
More informationUse of MRI in Evaluating Fetal Ventriculomegaly Lisa McLeod, Harvard Medical School Year III Gillian Lieberman, MD
January 2004 Use of MRI in Evaluating Fetal Ventriculomegaly Lisa McLeod, Harvard Medical School Year III http://bidmc.harvard.edu/content/departments/radiology/files/fetalatlas/default.htm Objectives:
More informationSupplementary webappendix
Supplementary webappendix This webappendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Kazui H, Miyajima M, Mori E, Ishikawa
More informationHEAD AND NECK IMAGING. James Chen (MS IV)
HEAD AND NECK IMAGING James Chen (MS IV) Anatomy Course Johns Hopkins School of Medicine Sept. 27, 2011 OBJECTIVES Introduce cross sectional imaging of head and neck Computed tomography (CT) Review head
More informationBiological Bases of Behavior. 3: Structure of the Nervous System
Biological Bases of Behavior 3: Structure of the Nervous System Neuroanatomy Terms The neuraxis is an imaginary line drawn through the spinal cord up to the front of the brain Anatomical directions are
More informationNeuroimaging approaches for elucidating disease mechanisms in hydrocephalus Mark E. Wagshul
Neuroimaging approaches for elucidating disease mechanisms in hydrocephalus Mark E. Wagshul Department of Radiology and Gruss MR Research Center Albert Einstein College of Medicine, Bronx, NY An analogy:
More informationWhile some patients with SIH recover without intervention
ORIGINAL RESEARCH P.H. Luetmer K.M. Schwartz L.J. Eckel C.H. Hunt R.E. Carter F.E. Diehn When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial
More informationventriculography compared, those with mass lesions involving the cerebral hemispheres were excluded.
Journal of Neurology, Neurosurgery, and Psychiatry, 1976, 39, 203-211 Computerized tomography (the EMAI Scanner): a comparison with pneumoencephalography and ventriculography J. GAWLER, G. H. DU BOULAY,
More informationintracranial anomalies
Chapter 5: Fetal Central Nervous System 84 intracranial anomalies Hydrocephaly Dilatation of ventricular system secondary to an increase in the amount of CSF. Effects of hydrocephalus include flattening
More informationThe influence of breathing on cerebrospinal fluid movement in the brain
The influence of breathing on cerebrospinal fluid movement in the brain A computational study based on in vivo pressure measurements Vegard Vinje Simula Research Laboratory GA Ringstad ME Rognes PK Eide
More informationSpontaneous Ventriculostomy: Report of Three Cases Revealed by Flow-Sensitive Phase-Contrast Cine MR Imaging
AJNR Am J Neuroradiol 20:1647 1652, October 1999 Case Report Spontaneous Ventriculostomy: Report of Three Cases Revealed by Flow-Sensitive Phase-Contrast Cine MR Imaging Alex Rovira, Jaume Capellades,
More informationHydrocephalus 1/16/2015. Hydrocephalus. Functions of Cerebrospinal fluid (CSF) Flow of CSF
Hydrocephalus Hydrocephalus Ruth Arms, MSN, CNS-BC, SCRN Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles
More informationOriginal Research JOURNAL OF MAGNETIC RESONANCE IMAGING 30: (2009)
JOURNAL OF MAGNETIC RESONANCE IMAGING 30:708 715 (2009) Original Research Value of Quantitative MRI Biomarkers (Evans Index, Aqueductal Flow Rate, and Apparent Diffusion Coefficient) in Idiopathic Normal
More informationTransient obstructive hydrocephalus due to intraventricular hemorrhage: A case report and review of literature
Digital Commons@Becker Open Access Publications 2013 Transient obstructive hydrocephalus due to intraventricular hemorrhage: A case report and review of literature Eriks A. Lusis Ananth K. Vellimana Wilson
More informationPrenatal Prediction of The Neurologically Impaired Neonate By Ultrasound
Prenatal Prediction of The Neurologically Impaired Neonate By Ultrasound Robert H. Debbs, D.O.,F.A.C.O.O.G. Professor of OB-GYN Perelman School of Medicine, University of Pennsylvania Director, Pennsylvania
More informationIndex. aneurysm, 92 carotid occlusion, 94 ICA stenosis, 95 intracranial, 92 MCA, 94
A ADC. See Apparent diffusion coefficient (ADC) Aneurysm cerebral artery aneurysm, 93 CT scan, 93 gadolinium, 93 Angiography, 13 Anoxic brain injury, 25 Apparent diffusion coefficient (ADC), 7 Arachnoid
More informationCSF Spaces in Idiopathic Normal Pressure Hydrocephalus: Morphology and Volumetry
AJNR Am J Neuroradiol 19:1277 1284, August 1998 CSF Spaces in Idiopathic Normal Pressure Hydrocephalus: Morphology and Volumetry Hajime Kitagaki, Etsuro Mori, Kazunari Ishii, Shigeru Yamaji, Nobutsugu
More informationThe resistance to CSF outflow in hydrocephalus what it is and what it isn t.
The resistance to CSF outflow in hydrocephalus what it is and what it isn t. Davson et al 1970, The mechanism of drainage of CSF. Brain 93:665-8 1989, Copenhagen, Alfred Benzon Foundation CSf outflow is
More informationIIH, previously known as pseudotumor cerebri, is a syndrome
ORIGINAL RESEARCH A.H. Aiken J.A. Hoots A.M. Saindane P.A. Hudgins Incidence of Cerebellar Tonsillar Ectopia in Idiopathic Intracranial Hypertension: A Mimic of the Chiari I Malformation BACKGROUND AND
More informationDeath after late failure of third ventriculostomy in children
J Neurosurg 97:211 215, 2002 Death after late failure of third ventriculostomy in children Report of three cases WALTER J. HADER, M.D., F.R.C.S.(C), JAMES DRAKE, M.D., F.R.C.S.(C), DOUGLAS COCHRANE, M.D.,
More informationSlide 1. Slide 2. Slide 3. Tomography vs Topography. Computed Tomography (CT): A simplified Topographical review of the Brain. Learning Objective
Slide 1 Computed Tomography (CT): A simplified Topographical review of the Brain Jon Wheiler, ACNP-BC Slide 2 Tomography vs Topography Tomography: A technique for displaying a representation of a cross
More informationIdiopathic normal-pressure hydrocephalus. Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts
J Neurosurg 52:371-377, 1980 Idiopathic normal-pressure hydrocephalus Results of shunting in 62 patients PETER McL. BLACK, M.D., PH.D. Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts
More informationIncreased Intracranial Volume: A Clue to the Etiology of Idiopathic Normal-Pressure Hydrocephalus?
AJNR Am J Neuroradiol 25:1479 1484, October 2004 Increased Intracranial Volume: A Clue to the Etiology of Idiopathic Normal-Pressure Hydrocephalus? William G. Bradley, Francis G. Safar, Claudia Hurtado,
More informationMANAGEMENT OF CSF. Steven D. Schaefer, MD, FACS. Department of Otolaryngology New York Eye and Ear Infirmary
MANAGEMENT OF CSF RHINORRHEA, MENIGIOCELES, Steven D. Schaefer, MD, FACS Professor and Chair Department of Otolaryngology New York Eye and Ear Infirmary New York Medical College Anatomy and Physiology
More informationCT Based Study of Frontal Horn Ratio And Ventricular Index in South Indian Population
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 7 Ver. VI (July. 2017), PP 55-59 www.iosrjournals.org CT Based Study of Frontal Horn Ratio
More informationsecondary effects and sequelae of head trauma.
Neuroimaging of vascular/secondary secondary effects and sequelae of head trauma. Andrès Server Alonso Department of Neuroradiology Division of Radiology Ullevål University Hospital Oslo, Norway. Guidelines
More informationCEREBRO SPINAL FLUID ANALYSIS IN BRAIN TUMOUR
CEREBRO SPINAL FLUID ANALYSIS IN BRAIN TUMOUR Sankar K 1, Shankar N 2, Anushya 3, ShymalaDevi 4, Purvaja 5 3,4,5 III Biomedical Student, Alpha college of Engineering, Chennai. kssankar10@yahoo.co.in 1,
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationA case of normal pressure hydrocephalus with peripheral vestibular disorder-like findings.
A case of normal pressure hydrocephalus with peripheral vestibular disorder-like findings. Yuzuru Sainoo 1)2), Hidetaka Kumagami 3), Haruo Takahashi 1) 1) Goto Chuoh Hospital, Otorhinolaryngology 2) Department
More informationAqueductal CSF stroke volume (ACSV) measured by
ORIGINAL RESEARCH A. Scollato P. Gallina B. Gautam G. Pellicanò C. Cavallini R. Tenenbaum N. Di Lorenzo Changes in Aqueductal CSF Stroke Volume in Shunted Patients with Idiopathic Normal-Pressure Hydrocephalus
More informationMR Evaluation of Hydrocephalus
591 MR Evaluation of Hydrocephalus Taher EI Gammal 1 Marshall B. Allen, Jr. 2 Betty Sue Brooks 1 Edward K. Mark2 An analysis of sagittal T1-weighted MR studies was performed in 23 patients with hydrocephalus,
More informationDecompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation
(2002) 40, 501 ± 506 ã 2002 International Society All rights reserved 1362 ± 4393/02 $25.00 www.nature.com/sc Original Article Decompression of the spinal subarachnoid space as a solution for syringomyelia
More informationCerebrospinal fluid hydrodynamics in type I Chari malformation
Cerebrospinal fluid hydrodynamics in type I Chari malformation Nicholas Shaffer 1, Bryn Martin 2, Francis Loth 1 1 Departments of Mechanical Engineering and Biomedical Engineering, University of Akron,
More informationCerebrospinal Fluid Velocity Amplitudes within the Cerebral Aqueduct in Healthy
Page 1 of 30 1 Cerebrospinal Fluid Velocity Amplitudes within the Cerebral Aqueduct in Healthy Children and Patients with Chiari I Malformation This is the author manuscript accepted for publication and
More informationUNDERSTANDING HYDROCEPHALUS
UNDERSTANDING HYDROCEPHALUS Offering solutions for patients. 1 UNDERSTANDING HYDROCEPHALUS Dear Reader: Your doctor has either recommended the CODMAN HAKIM Precision Fixed Pressure Valve, the CODMAN HAKIM
More informationMorphometric Study of the Midsagittal MR Imaging Plane in Cases of Hydrocephalus and Atrophy and in Normal Brains
AJNR Am J Neuroradiol 22:1674 1679, October 2001 Morphometric Study of the Midsagittal MR Imaging Plane in Cases of Hydrocephalus and Atrophy and in Normal Brains Yoram Segev, Ur Metser, Liana Beni-Adani,
More informationCerebral hemisphere. Parietal Frontal Occipital Temporal
Cerebral hemisphere Sulcus / Fissure Central Precental gyrus Postcentral gyrus Lateral (cerebral) Parieto-occipital Cerebral cortex Frontal lobe Parietal lobe Temporal lobe Insula Amygdala Hippocampus
More informationQuantitative analysis of intraspinal cerebrospinal fluid flow in normal adults
NEURAL REGENERATION RESEARCH Volume 7, Issue 15, May 2012 www.nrronline.org Cite this article as: Neural Regen Res. 2012;7(15):1164-1169. Quantitative analysis of intraspinal cerebrospinal fluid flow in
More informationMeningeal thickening in MRI: from signs to etiologies
Meningeal thickening in MRI: from signs to etiologies Poster No.: C-1979 Congress: ECR 2016 Type: Educational Exhibit Authors: A. Hssine, N. Mallat, M. Limeme, H. Zaghouani, S. Majdoub, H. Amara, D. Bakir,
More informationVentricles, CSF & Meninges. Steven McLoon Department of Neuroscience University of Minnesota
Ventricles, CSF & Meninges Steven McLoon Department of Neuroscience University of Minnesota 1 Coffee Hour Thursday (Sept 14) 8:30-9:30am Surdyk s Café in Northrop Auditorium Stop by for a minute or an
More informationCSF. Cerebrospinal Fluid(CSF) System
Cerebrospinal Fluid(CSF) System By the end of the lecture, students must be able to describe Physiological Anatomy of CSF Compartments Composition Formation Circulation Reabsorption CSF Pressure Functions
More informationCentral nervous system (CNS): brain and spinal cord Collections of cell body and dendrites (grey matter) are called nuclei/nucleus Nucleus can also
Chapter 3 Part 1 Orientation Directions in the nervous system are described relatively to the neuraxis An imaginary line drawn through the center of the length of the central nervous system, from the bottom
More informationIntracranial hypotension secondary to spinal CSF leak: diagnosis
Intracranial hypotension secondary to spinal CSF leak: diagnosis Spinal cerebrospinal fluid (CSF) leak is an important and underdiagnosed cause of new onset headache that is treatable. Cerebrospinal fluid
More informationMRI and CT of the CNS
MRI and CT of the CNS Dr.Maha ELBeltagy Assistant Professor of Anatomy Faculty of Medicine The University of Jordan 2018 Computed Tomography CT is used for the detection of intracranial lesions. CT relies
More informationChapter 14. The Brain Meninges and Cerebral Spinal Fluid
Chapter 14 The Brain Meninges and Cerebral Spinal Fluid Meninges of the Brain Skull Brain: Blood vessel Pia mater Gray matter White matter Dura mater: Periosteal layer Meningeal layer Arachnoid villus
More informationTECHNICAL NOTE. Introduction
Magn Reson Med Sci 2017; XX; XXX XXX doi:10.2463/mrms.tn.2017-0032 Published Online: August 24, 2017 TECHNICAL NOTE Time-spatial Labeling Inversion Pulse (Time-SLIP) with Pencil Beam Pulse: A Selective
More informationCharacteristic features of CNS pathology. By: Shifaa AlQa qa
Characteristic features of CNS pathology By: Shifaa AlQa qa Normal brain: - The neocortex (gray matter): six layers: outer plexiform, outer granular, outer pyramidal, inner granular, inner pyramidal, polymorphous
More informationLumbar infusion test in normal pressure hydrocephalus
Acta Neurol Scand 2005: 111: 379 384 DOI: 10.1111/j.1600-0404.2005.00417.x Copyright Ó Blackwell Munksgaard 2005 ACTA NEUROLOGICA SCANDINAVICA Lumbar infusion test in normal pressure hydrocephalus Kahlon
More information